Assignment: Nursing Case Study
History
A fully functional, independent woman who is nearly 100 years old and lives with her 2 daughters. She has a Glasgow coma scale (GCS) of 15. A history finds that she has:
o Hypertension
o Coronary artery disease
o Congestive heart failure
o Cataracts
o Hearing impairments
o Knee osteoarthritis
o IDDM
Her medications are Lisinopril 10mg daily, furosemide 40 mg daily, ASA 81 mg po, and metoprolol 50mg XL bid.
a. What sensory deficient needs to be addressed before talking to the client?
b. What does a GCS of 15 mean?
c. With the medications -list the classification of each drug and its action. With Lisinopril what electrolyte and dietary precaution needs to be addressed? What major side effect of Lisinopril would cause involvement of the dermis, subcutaneous tissue, and the mucosa? What does ASA do the platelets? How does metoprolol affect the blood sugar?
d. Of these drugs ordered which one would the nurse question?
Presentation and Examination
Patient develops abdominal pain increasing over 5 days; obstipation for 1 day. She is acutely ill and she appeared uncomfortable and volume depleted. On exam, she has abdominal distention, hypoactive bowel sound and no mass is found. Her heart is enlarged and has an S3. Her 2 D echo shows Mitral stenosis and an EF of 45%. Her abdominal Cat Scan shows a intussusception of the large intestine. A NGT is inserted. Labs are as follows:
Laboratory findings:
o WBC..................13, 290
o HCT...................42
o Na.....................128
o K.......................2.6
o Bun/creatinine.....30/1.1
o Lactic acid......... >5 mmol/L
VS: T 100F, 110, RR 16 BP 100/72
a. What is intussusception and what treatment does it require?
b. When placing an NGT the nurse knows that a certain way to measure it? Describe how it is to be done?
c. What is the normal lactic level and what does it show in this scenario? What does the BUN/ CR indicate? What other abnormal lab work would be a priority to address and what measures would the nurse need to initiate?
d. What crystalloid would be used to hydrate the client?
e. What is abnormal of her vital signs and why? What is her Mean arterial pressure and her pulse pressure - describe the terms and the normal levels?
Format your assignment according to the give formatting requirements:
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b. The response also includes a cover page containing the title of the assignment, the course title, the student's name, and the date. The cover page is not included in the required page length.
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